|
PR LAP,VAG HYST,UTERUS >250GMS,SALP-OOPH
|
Professional
|
$2,377.46
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
z58554
|
| Min. Negotiated Rate |
$1,218.45 |
| Max. Negotiated Rate |
$2,071.36 |
| Rate for Payer: Aetna Medicare |
$1,218.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,696.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,696.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,401.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,340.30
|
| Rate for Payer: Cash Price |
$1,474.03
|
| Rate for Payer: Cash Price |
$1,474.03
|
| Rate for Payer: Coventry All Commercial |
$1,462.14
|
| Rate for Payer: Frontpath All Commercial |
$1,712.85
|
| Rate for Payer: Humana ChoiceCare |
$1,436.63
|
| Rate for Payer: Humana Medicare |
$1,218.45
|
| Rate for Payer: Lucent All Commercial |
$2,071.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,706.00
|
| Rate for Payer: PHCS All Commercial |
$1,783.10
|
| Rate for Payer: PHP All Commercial |
$1,569.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,218.45
|
| Rate for Payer: Signature Care EPO |
$1,598.85
|
| Rate for Payer: Signature Care PPO |
$1,598.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare Commercial |
$1,474.61
|
| Rate for Payer: United Healthcare Medicare |
$1,218.45
|
|
|
PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH
|
Professional
|
$1,791.24
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
z58552
|
| Min. Negotiated Rate |
$918.01 |
| Max. Negotiated Rate |
$1,560.62 |
| Rate for Payer: Aetna Medicare |
$918.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,327.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,327.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,055.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,009.81
|
| Rate for Payer: Cash Price |
$1,110.57
|
| Rate for Payer: Cash Price |
$1,110.57
|
| Rate for Payer: Coventry All Commercial |
$1,101.61
|
| Rate for Payer: Frontpath All Commercial |
$1,285.15
|
| Rate for Payer: Humana ChoiceCare |
$1,064.38
|
| Rate for Payer: Humana Medicare |
$918.01
|
| Rate for Payer: Lucent All Commercial |
$1,560.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,285.00
|
| Rate for Payer: PHCS All Commercial |
$1,343.43
|
| Rate for Payer: PHP All Commercial |
$1,182.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$918.01
|
| Rate for Payer: Signature Care EPO |
$1,277.55
|
| Rate for Payer: Signature Care PPO |
$1,277.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,193.00
|
| Rate for Payer: United Healthcare Commercial |
$1,099.54
|
| Rate for Payer: United Healthcare Medicare |
$918.01
|
|
|
PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC
|
Professional
|
$236.42
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
z31575
|
| Min. Negotiated Rate |
$63.44 |
| Max. Negotiated Rate |
$177.32 |
| Rate for Payer: Aetna Medicare |
$63.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$145.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.78
|
| Rate for Payer: Cash Price |
$146.58
|
| Rate for Payer: Cash Price |
$146.58
|
| Rate for Payer: Coventry All Commercial |
$76.13
|
| Rate for Payer: Frontpath All Commercial |
$85.57
|
| Rate for Payer: Humana ChoiceCare |
$89.58
|
| Rate for Payer: Humana Medicare |
$63.44
|
| Rate for Payer: Lucent All Commercial |
$107.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: PHCS All Commercial |
$177.32
|
| Rate for Payer: PHP All Commercial |
$86.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.44
|
| Rate for Payer: Signature Care EPO |
$154.70
|
| Rate for Payer: Signature Care PPO |
$154.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.00
|
| Rate for Payer: United Healthcare Commercial |
$85.55
|
| Rate for Payer: United Healthcare Medicare |
$63.44
|
|
|
PR LARYNGOSCOPY,INDIRECT+INJECT CORD
|
Professional
|
$238.32
|
|
|
Service Code
|
CPT 31513
|
| Hospital Charge Code |
z31513
|
| Min. Negotiated Rate |
$122.14 |
| Max. Negotiated Rate |
$207.64 |
| Rate for Payer: Aetna Medicare |
$122.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.35
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: Cash Price |
$147.76
|
| Rate for Payer: Coventry All Commercial |
$146.57
|
| Rate for Payer: Frontpath All Commercial |
$167.48
|
| Rate for Payer: Humana ChoiceCare |
$161.01
|
| Rate for Payer: Humana Medicare |
$122.14
|
| Rate for Payer: Lucent All Commercial |
$207.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.00
|
| Rate for Payer: PHCS All Commercial |
$178.74
|
| Rate for Payer: PHP All Commercial |
$166.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$122.14
|
| Rate for Payer: Signature Care EPO |
$190.40
|
| Rate for Payer: Signature Care PPO |
$190.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$183.00
|
| Rate for Payer: United Healthcare Commercial |
$149.76
|
| Rate for Payer: United Healthcare Medicare |
$122.14
|
|
|
PR LATERAL RETINACULAR RELEASE OPEN
|
Professional
|
$831.22
|
|
|
Service Code
|
CPT 27425
|
| Hospital Charge Code |
z27425
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: Aetna Medicare |
$426.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$489.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$468.60
|
| Rate for Payer: Cash Price |
$515.36
|
| Rate for Payer: Cash Price |
$515.36
|
| Rate for Payer: Coventry All Commercial |
$511.20
|
| Rate for Payer: Frontpath All Commercial |
$586.52
|
| Rate for Payer: Humana ChoiceCare |
$463.71
|
| Rate for Payer: Humana Medicare |
$426.00
|
| Rate for Payer: Lucent All Commercial |
$724.20
|
| Rate for Payer: PHCS All Commercial |
$623.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$426.00
|
| Rate for Payer: United Healthcare Commercial |
$468.04
|
| Rate for Payer: United Healthcare Medicare |
$426.00
|
|
|
PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM
|
Professional
|
$579.04
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
z12052
|
| Min. Negotiated Rate |
$156.88 |
| Max. Negotiated Rate |
$434.28 |
| Rate for Payer: Aetna Medicare |
$186.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$302.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$302.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$214.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.20
|
| Rate for Payer: Cash Price |
$359.00
|
| Rate for Payer: Cash Price |
$359.00
|
| Rate for Payer: Coventry All Commercial |
$223.86
|
| Rate for Payer: Frontpath All Commercial |
$252.64
|
| Rate for Payer: Humana ChoiceCare |
$156.88
|
| Rate for Payer: Humana Medicare |
$186.55
|
| Rate for Payer: Lucent All Commercial |
$317.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$243.00
|
| Rate for Payer: PHCS All Commercial |
$434.28
|
| Rate for Payer: PHP All Commercial |
$254.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$186.55
|
| Rate for Payer: Signature Care EPO |
$253.74
|
| Rate for Payer: Signature Care PPO |
$253.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$224.00
|
| Rate for Payer: United Healthcare Commercial |
$227.29
|
| Rate for Payer: United Healthcare Medicare |
$186.55
|
|
|
PR LAYR CLOS WND FACE,FACIAL <2.5 CM
|
Professional
|
$519.48
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
z12051
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$389.61 |
| Rate for Payer: Aetna Medicare |
$158.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$267.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$267.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.01
|
| Rate for Payer: Cash Price |
$322.08
|
| Rate for Payer: Cash Price |
$322.08
|
| Rate for Payer: Coventry All Commercial |
$189.83
|
| Rate for Payer: Frontpath All Commercial |
$214.38
|
| Rate for Payer: Humana ChoiceCare |
$146.70
|
| Rate for Payer: Humana Medicare |
$158.19
|
| Rate for Payer: Lucent All Commercial |
$268.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.00
|
| Rate for Payer: PHCS All Commercial |
$389.61
|
| Rate for Payer: PHP All Commercial |
$216.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$158.19
|
| Rate for Payer: Signature Care EPO |
$232.05
|
| Rate for Payer: Signature Care PPO |
$232.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$190.00
|
| Rate for Payer: United Healthcare Commercial |
$193.81
|
| Rate for Payer: United Healthcare Medicare |
$158.19
|
|
|
PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM
|
Professional
|
$667.02
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
z12053
|
| Min. Negotiated Rate |
$174.57 |
| Max. Negotiated Rate |
$500.26 |
| Rate for Payer: Aetna Medicare |
$201.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$332.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$231.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$221.19
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Coventry All Commercial |
$241.30
|
| Rate for Payer: Frontpath All Commercial |
$272.79
|
| Rate for Payer: Humana ChoiceCare |
$174.57
|
| Rate for Payer: Humana Medicare |
$201.08
|
| Rate for Payer: Lucent All Commercial |
$341.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.00
|
| Rate for Payer: PHCS All Commercial |
$500.26
|
| Rate for Payer: PHP All Commercial |
$274.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$201.08
|
| Rate for Payer: Signature Care EPO |
$292.77
|
| Rate for Payer: Signature Care PPO |
$292.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$241.00
|
| Rate for Payer: United Healthcare Commercial |
$231.38
|
| Rate for Payer: United Healthcare Medicare |
$201.08
|
|
|
PR LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM
|
Professional
|
$703.18
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
z12054
|
| Min. Negotiated Rate |
$191.67 |
| Max. Negotiated Rate |
$527.38 |
| Rate for Payer: Aetna Medicare |
$204.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$235.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$224.93
|
| Rate for Payer: Cash Price |
$435.97
|
| Rate for Payer: Cash Price |
$435.97
|
| Rate for Payer: Coventry All Commercial |
$245.38
|
| Rate for Payer: Frontpath All Commercial |
$281.54
|
| Rate for Payer: Humana ChoiceCare |
$191.67
|
| Rate for Payer: Humana Medicare |
$204.48
|
| Rate for Payer: Lucent All Commercial |
$347.62
|
| Rate for Payer: PHCS All Commercial |
$527.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$204.48
|
| Rate for Payer: United Healthcare Commercial |
$246.08
|
| Rate for Payer: United Healthcare Medicare |
$204.48
|
|
|
PR LAYR CLOS WND REST BODY 12.6-20 CM
|
Professional
|
$754.50
|
|
|
Service Code
|
CPT 12045
|
| Hospital Charge Code |
z12045
|
| Min. Negotiated Rate |
$222.97 |
| Max. Negotiated Rate |
$565.88 |
| Rate for Payer: Aetna Medicare |
$254.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$292.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.68
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Cash Price |
$467.79
|
| Rate for Payer: Coventry All Commercial |
$305.10
|
| Rate for Payer: Frontpath All Commercial |
$347.74
|
| Rate for Payer: Humana ChoiceCare |
$222.97
|
| Rate for Payer: Humana Medicare |
$254.25
|
| Rate for Payer: Lucent All Commercial |
$432.22
|
| Rate for Payer: PHCS All Commercial |
$565.88
|
| Rate for Payer: PHP All Commercial |
$347.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$254.25
|
| Rate for Payer: Signature Care EPO |
$325.69
|
| Rate for Payer: Signature Care PPO |
$325.69
|
| Rate for Payer: United Healthcare Commercial |
$265.03
|
| Rate for Payer: United Healthcare Medicare |
$254.25
|
|
|
PR LAYR CLOS WND REST BODY <2.5 CM
|
Professional
|
$484.06
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
z12041
|
| Min. Negotiated Rate |
$131.76 |
| Max. Negotiated Rate |
$363.04 |
| Rate for Payer: Aetna Medicare |
$135.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$155.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.10
|
| Rate for Payer: Cash Price |
$300.12
|
| Rate for Payer: Cash Price |
$300.12
|
| Rate for Payer: Coventry All Commercial |
$162.66
|
| Rate for Payer: Frontpath All Commercial |
$183.18
|
| Rate for Payer: Humana ChoiceCare |
$131.76
|
| Rate for Payer: Humana Medicare |
$135.55
|
| Rate for Payer: Lucent All Commercial |
$230.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$176.00
|
| Rate for Payer: PHCS All Commercial |
$363.04
|
| Rate for Payer: PHP All Commercial |
$185.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.55
|
| Rate for Payer: Signature Care EPO |
$212.92
|
| Rate for Payer: Signature Care PPO |
$212.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$163.00
|
| Rate for Payer: United Healthcare Commercial |
$181.16
|
| Rate for Payer: United Healthcare Medicare |
$135.55
|
|
|
PR LAYR CLOS WND REST BODY 2.6-7.5 CM
|
Professional
|
$568.28
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
z12042
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$426.21 |
| Rate for Payer: Aetna Medicare |
$182.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$289.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$289.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$210.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$201.18
|
| Rate for Payer: Cash Price |
$352.33
|
| Rate for Payer: Cash Price |
$352.33
|
| Rate for Payer: Coventry All Commercial |
$219.47
|
| Rate for Payer: Frontpath All Commercial |
$248.05
|
| Rate for Payer: Humana ChoiceCare |
$156.78
|
| Rate for Payer: Humana Medicare |
$182.89
|
| Rate for Payer: Lucent All Commercial |
$310.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.00
|
| Rate for Payer: PHCS All Commercial |
$426.21
|
| Rate for Payer: PHP All Commercial |
$249.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.89
|
| Rate for Payer: Signature Care EPO |
$249.53
|
| Rate for Payer: Signature Care PPO |
$249.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$219.00
|
| Rate for Payer: United Healthcare Commercial |
$211.79
|
| Rate for Payer: United Healthcare Medicare |
$182.89
|
|
|
PR LAYR CLOS WND REST BODY 7.6-12.5 CMS
|
Professional
|
$697.60
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
z12044
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$523.20 |
| Rate for Payer: Aetna Medicare |
$199.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$334.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$334.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.06
|
| Rate for Payer: Cash Price |
$432.51
|
| Rate for Payer: Cash Price |
$432.51
|
| Rate for Payer: Coventry All Commercial |
$238.98
|
| Rate for Payer: Frontpath All Commercial |
$272.28
|
| Rate for Payer: Humana ChoiceCare |
$178.40
|
| Rate for Payer: Humana Medicare |
$199.15
|
| Rate for Payer: Lucent All Commercial |
$338.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: PHCS All Commercial |
$523.20
|
| Rate for Payer: PHP All Commercial |
$272.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.15
|
| Rate for Payer: Signature Care EPO |
$305.41
|
| Rate for Payer: Signature Care PPO |
$305.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.00
|
| Rate for Payer: United Healthcare Commercial |
$228.39
|
| Rate for Payer: United Healthcare Medicare |
$199.15
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM
|
Professional
|
$482.24
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
z12031
|
| Min. Negotiated Rate |
$117.25 |
| Max. Negotiated Rate |
$361.68 |
| Rate for Payer: Aetna Medicare |
$141.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$247.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$247.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.73
|
| Rate for Payer: Cash Price |
$298.99
|
| Rate for Payer: Cash Price |
$298.99
|
| Rate for Payer: Coventry All Commercial |
$169.88
|
| Rate for Payer: Frontpath All Commercial |
$191.41
|
| Rate for Payer: Humana ChoiceCare |
$117.25
|
| Rate for Payer: Humana Medicare |
$141.57
|
| Rate for Payer: Lucent All Commercial |
$240.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.00
|
| Rate for Payer: PHCS All Commercial |
$361.68
|
| Rate for Payer: PHP All Commercial |
$193.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$141.57
|
| Rate for Payer: Signature Care EPO |
$211.83
|
| Rate for Payer: Signature Care PPO |
$211.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$170.00
|
| Rate for Payer: United Healthcare Commercial |
$169.05
|
| Rate for Payer: United Healthcare Medicare |
$141.57
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM
|
Professional
|
$556.42
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
z12032
|
| Min. Negotiated Rate |
$158.05 |
| Max. Negotiated Rate |
$417.32 |
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$289.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$289.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$344.98
|
| Rate for Payer: Cash Price |
$344.98
|
| Rate for Payer: Coventry All Commercial |
$212.92
|
| Rate for Payer: Frontpath All Commercial |
$238.80
|
| Rate for Payer: Humana ChoiceCare |
$158.05
|
| Rate for Payer: Humana Medicare |
$177.43
|
| Rate for Payer: Lucent All Commercial |
$301.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$231.00
|
| Rate for Payer: PHCS All Commercial |
$417.32
|
| Rate for Payer: PHP All Commercial |
$242.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$177.43
|
| Rate for Payer: Signature Care EPO |
$256.70
|
| Rate for Payer: Signature Care PPO |
$256.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$213.00
|
| Rate for Payer: United Healthcare Commercial |
$207.63
|
| Rate for Payer: United Healthcare Medicare |
$177.43
|
|
|
PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM
|
Professional
|
$611.32
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
z12034
|
| Min. Negotiated Rate |
$164.58 |
| Max. Negotiated Rate |
$458.49 |
| Rate for Payer: Aetna Medicare |
$191.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$301.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.50
|
| Rate for Payer: Cash Price |
$379.02
|
| Rate for Payer: Cash Price |
$379.02
|
| Rate for Payer: Coventry All Commercial |
$229.63
|
| Rate for Payer: Frontpath All Commercial |
$261.33
|
| Rate for Payer: Humana ChoiceCare |
$164.58
|
| Rate for Payer: Humana Medicare |
$191.36
|
| Rate for Payer: Lucent All Commercial |
$325.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$249.00
|
| Rate for Payer: PHCS All Commercial |
$458.49
|
| Rate for Payer: PHP All Commercial |
$261.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.36
|
| Rate for Payer: Signature Care EPO |
$268.35
|
| Rate for Payer: Signature Care PPO |
$268.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$230.00
|
| Rate for Payer: United Healthcare Commercial |
$217.51
|
| Rate for Payer: United Healthcare Medicare |
$191.36
|
|
|
PR LENGTH/SHORT LEG/ANKL TENDON,SINGLE
|
Professional
|
$1,200.08
|
|
|
Service Code
|
CPT 27685
|
| Hospital Charge Code |
z27685
|
| Min. Negotiated Rate |
$438.46 |
| Max. Negotiated Rate |
$900.06 |
| Rate for Payer: Aetna Medicare |
$438.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$504.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$482.31
|
| Rate for Payer: Cash Price |
$744.05
|
| Rate for Payer: Cash Price |
$744.05
|
| Rate for Payer: Coventry All Commercial |
$526.15
|
| Rate for Payer: Frontpath All Commercial |
$598.52
|
| Rate for Payer: Humana ChoiceCare |
$518.56
|
| Rate for Payer: Humana Medicare |
$438.46
|
| Rate for Payer: Lucent All Commercial |
$745.38
|
| Rate for Payer: PHCS All Commercial |
$900.06
|
| Rate for Payer: PHP All Commercial |
$744.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$438.46
|
| Rate for Payer: Signature Care EPO |
$840.65
|
| Rate for Payer: Signature Care PPO |
$840.65
|
| Rate for Payer: United Healthcare Commercial |
$521.46
|
| Rate for Payer: United Healthcare Medicare |
$438.46
|
|
|
PR LEUPROLIDE ACETATE /3.75 MG
|
Professional
|
$1,493.63
|
|
|
Service Code
|
CPT J1950
|
| Hospital Charge Code |
zJ1950
|
| Min. Negotiated Rate |
$1,474.18 |
| Max. Negotiated Rate |
$1,493.63 |
| Rate for Payer: Humana ChoiceCare |
$1,474.18
|
| Rate for Payer: PHP All Commercial |
$1,493.63
|
|
|
PR LIDOCAINE INJECTION
|
Professional
|
$0.04
|
|
|
Service Code
|
CPT J2001
|
| Hospital Charge Code |
zJ2001
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Humana ChoiceCare |
$0.03
|
| Rate for Payer: PHP All Commercial |
$0.04
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
|
|
PR LIGATE FALLOPIAN TUBE
|
Professional
|
$679.06
|
|
|
Service Code
|
CPT 58600
|
| Hospital Charge Code |
z58600
|
| Min. Negotiated Rate |
$348.02 |
| Max. Negotiated Rate |
$591.63 |
| Rate for Payer: Aetna Medicare |
$348.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$469.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$469.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$400.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$382.82
|
| Rate for Payer: Cash Price |
$421.02
|
| Rate for Payer: Cash Price |
$421.02
|
| Rate for Payer: Coventry All Commercial |
$417.62
|
| Rate for Payer: Frontpath All Commercial |
$484.82
|
| Rate for Payer: Humana ChoiceCare |
$394.79
|
| Rate for Payer: Humana Medicare |
$348.02
|
| Rate for Payer: Lucent All Commercial |
$591.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$487.00
|
| Rate for Payer: PHCS All Commercial |
$509.30
|
| Rate for Payer: PHP All Commercial |
$448.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$348.02
|
| Rate for Payer: Signature Care EPO |
$441.15
|
| Rate for Payer: Signature Care PPO |
$441.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$452.00
|
| Rate for Payer: United Healthcare Commercial |
$407.83
|
| Rate for Payer: United Healthcare Medicare |
$348.02
|
|
|
PR LIGATE FALLOPIAN TUBE,POSTPARTUM
|
Professional
|
$617.10
|
|
|
Service Code
|
CPT 58605
|
| Hospital Charge Code |
z58605
|
| Min. Negotiated Rate |
$316.27 |
| Max. Negotiated Rate |
$537.66 |
| Rate for Payer: Aetna Medicare |
$316.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$425.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$425.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$363.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$347.90
|
| Rate for Payer: Cash Price |
$382.60
|
| Rate for Payer: Cash Price |
$382.60
|
| Rate for Payer: Coventry All Commercial |
$379.52
|
| Rate for Payer: Frontpath All Commercial |
$441.94
|
| Rate for Payer: Humana ChoiceCare |
$358.00
|
| Rate for Payer: Humana Medicare |
$316.27
|
| Rate for Payer: Lucent All Commercial |
$537.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$443.00
|
| Rate for Payer: PHCS All Commercial |
$462.82
|
| Rate for Payer: PHP All Commercial |
$407.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$316.27
|
| Rate for Payer: Signature Care EPO |
$400.35
|
| Rate for Payer: Signature Care PPO |
$400.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$411.00
|
| Rate for Payer: United Healthcare Commercial |
$370.58
|
| Rate for Payer: United Healthcare Medicare |
$316.27
|
|
|
PR LIGATION,FALLOPIAN TUBE W/C-SECTION
|
Professional
|
$137.46
|
|
|
Service Code
|
CPT 58611
|
| Hospital Charge Code |
z58611
|
| Min. Negotiated Rate |
$70.45 |
| Max. Negotiated Rate |
$119.76 |
| Rate for Payer: Aetna Medicare |
$70.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$81.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.50
|
| Rate for Payer: Cash Price |
$85.23
|
| Rate for Payer: Cash Price |
$85.23
|
| Rate for Payer: Coventry All Commercial |
$84.54
|
| Rate for Payer: Frontpath All Commercial |
$99.63
|
| Rate for Payer: Humana ChoiceCare |
$90.68
|
| Rate for Payer: Humana Medicare |
$70.45
|
| Rate for Payer: Lucent All Commercial |
$119.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.00
|
| Rate for Payer: PHCS All Commercial |
$103.10
|
| Rate for Payer: PHP All Commercial |
$90.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.45
|
| Rate for Payer: Signature Care EPO |
$99.45
|
| Rate for Payer: Signature Care PPO |
$99.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.00
|
| Rate for Payer: United Healthcare Commercial |
$89.28
|
| Rate for Payer: United Healthcare Medicare |
$70.45
|
|
|
PR LIGMT REVISION,KNEE,EXTRA-ARTIC
|
Professional
|
$1,293.36
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
z27427
|
| Min. Negotiated Rate |
$662.85 |
| Max. Negotiated Rate |
$1,126.84 |
| Rate for Payer: Aetna Medicare |
$662.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$950.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$950.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$762.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$729.14
|
| Rate for Payer: Cash Price |
$801.88
|
| Rate for Payer: Cash Price |
$801.88
|
| Rate for Payer: Coventry All Commercial |
$795.42
|
| Rate for Payer: Frontpath All Commercial |
$923.65
|
| Rate for Payer: Humana ChoiceCare |
$748.55
|
| Rate for Payer: Humana Medicare |
$662.85
|
| Rate for Payer: Lucent All Commercial |
$1,126.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,061.00
|
| Rate for Payer: PHCS All Commercial |
$970.02
|
| Rate for Payer: PHP All Commercial |
$1,125.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$662.85
|
| Rate for Payer: Signature Care EPO |
$998.75
|
| Rate for Payer: Signature Care PPO |
$998.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$994.00
|
| Rate for Payer: United Healthcare Commercial |
$775.06
|
| Rate for Payer: United Healthcare Medicare |
$662.85
|
|
|
PR LONG ARM CAST, ADULT
|
Professional
|
$38.92
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050A
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$29.19 |
| Rate for Payer: Cash Price |
$24.13
|
| Rate for Payer: PHCS All Commercial |
$29.19
|
| Rate for Payer: Signature Care EPO |
$26.47
|
| Rate for Payer: Signature Care PPO |
$26.47
|
|
|
PR LONG ARM CAST, PEDIATRIC
|
Professional
|
$33.41
|
|
|
Service Code
|
CPT Q4050
|
| Hospital Charge Code |
zQ4050B
|
| Min. Negotiated Rate |
$22.72 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Cash Price |
$20.71
|
| Rate for Payer: PHCS All Commercial |
$25.06
|
| Rate for Payer: Signature Care EPO |
$22.72
|
| Rate for Payer: Signature Care PPO |
$22.72
|
|
